If you have HBO Max, standup comic Alex Edelman’s one-man show was excellent. The official description of its main narrative thread: “In the wake of a string of anti–Semitic threats pointed in his direction online, standup comic Alex Edelman decides to go straight to the source; specifically, Queens, where he covertly attends a meeting of White Nationalists.” Here’s the trailer.
On April 23 at 2 pm ET, the FTC is holding a special open meeting with a live webcast to discuss the proposed final rule banning most noncompete clauses. At the end of the meeting, “the Commission will vote on whether to issue the final rule.”
Potentially huge news (that will then likely be challenged legally).
This post is for anyone who is lost and dejected after failing one of the Step exams.
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First, I’m sorry that you’re going through this. The path to becoming a doctor is long and hard, but there’s something unique about high-stakes testing that adds stress and uncertainty.
I know this may sound a little odd/dramatic, but I think dealing with a big testing disappointment is ultimately the same as any other grieving process. The world today isn’t the world you wanted to live in, and it takes some time to bridge the gap between where you thought you were and where you currently are. The silver lining is that–unlike losing a loved one or a serious injury–you can still get back on the path.
At the same time, while it would be nice to get the failure notice and be able to immediately double down into an amazingly efficient targeted revision process for your next attempt, you’re also a human being. You’re a human being who deserves to grieve.
Maybe you won’t go through the classic stages of grief like denial, anger, bargaining, depression, and ultimately acceptance. But you might, and there’s nothing wrong with that. Just because there are so many worse things in the world doesn’t magically make this experience not suck. Don’t add insult to injury and beat yourself up for being acutely sad.
(On a related note, I think this would also be a good time to take a serious look at your media diet)
Once you have the timeline for your next attempt and know your school schedule, it’s time to be systematic about how to use that time effectively. That should absolutely include some time initially to reset psychologically. For a week or two, make specific time and force yourself to do some things that you enjoy and find centering. You need a less heavy heart to remember why you are on this pathway and why you’re willing to work hard to get to your destination. You can’t only punish yourself for this disappointment with things that rub salt in the wound.
Next, it’s time to analyze your current performance abilities for areas of weakness, both subject matter and testing approach (see below). It may be tempting to add a bunch of new resources or completely change how you study. In some cases that may be the right choice, particularly if you haven’t been incorporating enough questions or have never heard of spaced repetition, but for many people the answer is doubling down on a limited number of high-yield resources and not breadth. If you were close to passing, you probably don’t need to reinvent the wheel.
You do need to prioritize your mental and physical health (trite but true). Diet, exercise, and sleep are huge performance factors that you have a lot of control over.
The bottom line is that you are allowed to feel sad, and you’re allowed to mourn for the world where your pathway to becoming a doctor was smooth and straightforward and where you never need to question yourself or prepare a story for others. It’s something you can and absolutely will deal with, but there’s no reason to pretend that you don’t deserve to be bummed. That’s just toxic positivity. It does suck, and it is a bummer.
But you also need to believe that you will absolutely get past this. It’s a hurdle. And hurdles are meant to be overcome.
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For further test-taking reading:
It’s recruitment season, the radiology job market is hot, and there’s a lot of corporate noise. I’m thinking of maybe starting the world’s smallest radiology job board right here, open exclusively to a limited handful of 100% independent private practices.
If your group is interested in advertising on this site (and also therefore supporting my writing), email me at ben@benwhite.com.
Recruitment is a big challenge. While the ACR subsequently addressed the issue I wrote about here, I originally had the idea because of this.
Incredible story briefly detailed in NYT’s “Did One Guy Just Stop a Huge Cyberattack?” by Kevin Roose:
In the cybersecurity world, a database engineer inadvertently finding a backdoor in a core Linux feature is a little like a bakery worker who smells a freshly baked loaf of bread, senses something is off and correctly deduces that someone has tampered with the entire global yeast supply. It’s the kind of intuition that requires years of experience and obsessive attention to detail, plus a healthy dose of luck.
This could have been an unmitigated disaster. So much of the world’s infrastructure relies on random individuals being generally good or exceptionally thoughtful, in this case, the diligence of some dude who describes himself as a “private person who just sits in front of the computer and hacks on code.”
But, on the darker side: Given the seemingly miraculous nature of this catch, what are the odds there aren’t other backdoors already in place in our key systems?
In Show Your Work, Austin Kleon argues “the best way to get started on the path to sharing your work is to think about what you want to learn, and make a commitment to learning it in front of others.” That’s what I’ve been doing since 2009.
One downside of Showing Your Work is when the showing of the work is the only work you do. I never set out to be a blogger (cringey moniker that it is). Not that there’s anything wrong with this site (I think it’s pretty good?), but it’s undeniably the lower-hanging fruit that I’ve been doing for 15 years while mostly not writing the books and stories I originally intended to write. We could call it productive procrastination.
Now that’s not entirely fair, because it turns out that I also like whatever this is. I like writing short, I always have—I edited a nanofiction literary journal for 14 years for heaven’s sake—and I like curating, sharing, teaching people, helping others, and yes, even being a curmudgeon when the situation calls.
Kleon quotes David Foster Wallace, who said that good nonfiction was like watching “somebody reasonably bright but also reasonably average pay far closer attention and think at far more length about all sorts of different stuff than most of us have a chance to in our daily lives.” Which is I think is both generous and true.
So, I wish more people had websites, took the time to have a position or make something to share/teach, and then put it online.
For anyone considering graduating from transient social media reactions to starting a site to show their work, this gem from Clary Shirky:
The stupidest possible creative act is still a creative act. On the spectrum of creative work, the difference between the mediocre and the good is vast. Mediocrity is, however, still on the spectrum; you can move from mediocre to good in increments. The real gap is between doing nothing and doing something.
Medicine is, on the whole, underserved in the public sphere by its physicians. And the field of radiology, which has made up a significant fraction of my writing over recent years, certainly deserves more independent perspectives online than mine and a handful of others.
Don’t be scared to start small and reduce the barrier to entry for yourself. You can curate more than you generate, as old tech writer Jeff Jarvis advised: “Do what you do best and link to the rest.” (Last year I even added a smaller post-style microblog here to encourage myself to share more.)
I’ve enjoyed writing in my little corner of the internet and have no intention of stopping.
But, maybe there will be another book soon.
The current welcome bonus landscape:
- Curizon is entering new physician registrants in a drawing to win $100 (5 winners this month). The odds aren’t bad, several of my readers won last year!
- InCrowd is offering $10.
- M3 Global Research, M-Panels, and All Global Circle are each offering $10 for the following 12 specialties: Hematology / Oncology, Dermatology, Gastroenterology, Pulmonology, Cardiology, Family Medicine or General Practice, Neurology, Urology, Nephrology, Allergy and Immunology, Surgery, Psychiatry, or Rheumatology.
My complete list and more thorough descriptions can be found here.
In addition to being a way to earn extra money (and start a side business that enables you to take some business deductions or start a solo 401k), signing up through these links also helps support my writing. Thank you!
Post-match fourth year is a great usually “less-stressful” time to get your required education in personal finance. My free book is a nice, readable, and to-the-point primer on the essentials of personal finance including student loans. Read (or download it) here. Note that the new SAVE plan has simplified the student loan part for the majority of borrowers going forward.
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Not everyone should try to buy a house during residency. With the recent housing boom and higher interest rates, home ownership is probably out of reach for a larger proportion of residents than at any other time in recent history.
But, if you are considering trying to buy a home as a trainee, you’re likely going to need a physician mortgage. One quick way to get your feelers out to several potential companies at once is LeverageRx, a totally free handy platform that will let you rapidly comparison shop multiple physician loan lenders.
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Senior medical students are also eligible to try to lock in their eligibility for disability insurance. Disability insurance isn’t cheap–and you may not be able to afford it on your current budget–but again this is a great time to at least learn about it and price out some options and see. A small ~$2k/mo benefit medical student policy will often cost in the $40-60/mo range and will lock in future insurability. The folks at LeverageRx and Pattern both offer a great no-cost no-commitment way to see what your choices look like.
It’s always good to price out different options through different agents, and it’s possible the discounts available through your medical school affiliation are better than the ones you’ll have access to as a resident. Also, you’re unlikely to get younger and healthier. It’s worth doing some due diligence.
Life insurance, on the other hand, is straightforward: if you have a spouse or dependents that are relying on you, you need term life insurance.
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(Those are both affiliate links, which means that using them supports this site at no cost to you. My aging book is just free, no strings attached.)
From last year’s “Nutrition Science’s Most Preposterous Result” by David Merritt Johns in The Atlantic (“Studies show a mysterious health benefit to ice cream. Scientists don’t want to talk about it.”):
In 2004, the English epidemiologist Michael Marmot wrote, “Scientific findings do not fall on blank minds that get made up as a result. Science engages with busy minds that have strong views about how things are and ought to be.” Marmot was writing about how politicians deal with scientific evidence—always concluding that the latest data supported their existing views—but he acknowledged that scientists weren’t so different.
The ice-cream saga shows how this plays out in practice. Many stories can be told about any given scientific inquiry, and choosing one is a messy, value-laden process. A scientist may worry over how their story fits with common sense, and whether they have sufficient evidence to back it up. They may also worry that it poses a threat to public health, or to their credibility. If there’s a lesson to be drawn from the parable of the diet world’s most inconvenient truth, it’s that scientific knowledge is itself a packaged good. The data, whatever they show, are just ingredients.
The data are just ingredients.
Should new residents worry about workflow efficiency and ergonomics?
Yes.
I don’t think it’s ever too early to start thinking deliberately about what makes you better and more efficient in your job or able to act more sustainably. If anything, spending more time on workflow and ergonomics early on in your career is an investment in yourself.
As a resident, I just used whatever was plugged into the workstation I sat at. This eventually led to wrist pain, which even more eventually led me to finally address my setup as an attending. The physical discomfort became obvious. The hit on my productivity/efficiency for all those years was invisible until I made the changes.
Many people, especially once out in practice, become entrenched in their behavior patterns and find it very difficult and overwhelming to approach changing how they work, even when the change is clearly beneficial.
I would say, on a practical level, that it may take some time after starting residency to know what your needs are, what you like and don’t like about the default approach, and what an ideal workflow may be. But taking the basic step of buying a good mouse and programming it to help use PACS is an approachable and very helpful first step. At least do that, and then you can decide if you need to go down the rabbit hole.
The Approach
In general, you will find things easier especially as a resident if you can have a setup that requires no on-site software/driver installation, given the realities of bouncing around multiple workstations and the difficulties in working with your local IT department. Devices that can store their own settings and function plug-and-play on any computer are often described as having onboard memory.
I think a reasonable approach early on would at least involve some kind of gaming or productivity mouse to store window-level settings and your favorite PACS tools.
As you can see if you dive into my multi-post series, I personally divide these tasks between a left-hand device and a right-hand device and also incorporate dictation controls with Autohotkey. I think this is the optimal approach (and one that some of my residents have even now begun using). A dictaphone-free approach however really does require AutoHotkey to work efficiently, so utilizing this would depend on if you are able to get the executable file onto a workstation in order to run your shortcuts (or if the thing is locked down so tight that you won’t be able to). You may not know until you try or talk to someone local who has.
So, if you decide to take the streamlined approach and try to put all the PACS tools you want on a single device, you may find it helpful to have something with a large number of configurable buttons. A good example would be the reasonably priced UtechSmart VenusPro (a 16-button wireless mouse that includes a 12-button thumb grid). The G604 Lightspeed would be another popular choice (more expensive, adjustable scroll wheel, 6 thumb buttons). I personally use a “vertical” mouse, and I discuss even more mouse options (and everything else) at length in my “best stuff” post.
Unless your radiology department is more forward-thinking and responsive than most, whatever is plugged into your computer is unlikely to be a good mouse for utilizing PACS. Even if it is, it probably isn’t configured the way you want, so literally any variety of productivity or gaming mouse that you customize yourself will provide some obvious and immediate benefits. The ultimate goal is that you should not need to move your hand off your mouse (or put down your microphone) in order to use a keyboard for routine actions.
If you need to touch the keyboard for every case, I would say you’re doing it wrong.
How Many Buttons Do I Really Need?
Good question. Everyone is different.
Some potentially very helpful shortcuts will vary a little by how your PACS handles measurements (and deleting measurements) and things like zoom/pan. Some PACS automatically incorporate a manipulation tool like zooming into the central mouse wheel click or holding left/right mouse buttons simultaneously, whereas others require a keyboard shortcut. Some PACS will automatically helpfully change what the right click does depending on which PACS tool is active. Others do not. Some PACS delete measurements by double-clicking, and some make you press the delete key. That’s why it can be challenging to completely figure out what you want without some trial and error and becoming familiar with your local enterprise software function.
But here is one version:
Four window/level presets are probably sufficient for most people’s needs (e.g. soft tissue, lung, bone + brain or liver or your fourth favorite).
Some common choices for mouse button shortcuts are the measure tool, the ROI tool, delete, localizer/3D cursor to cross-register findings, and whatever button you need to turn back on power scrolling. Again, the exact details vary by PACS. That’s ~five more.
Most people would find the angle tool or spine labeling to be less important, but obviously in some cases those are in constant use, etc.
Add those together (~11) and it’s not hard to see how one can go crazy and fill up the thumb grid on one of these mice with all tools you need, even if you aren’t trying to add toggling dictation + previous/next template fields as well (3 more).
I will admit that it can be hard to retain all of these in muscle memory, which is one reason why I like using both hands.
Ultimately, the more things become easy for you to do, the more frustrating it is when some task requires you to break your flow.
Take Home
Yes, you should at least get a good programmable mouse for work.